Hiv Aids Sexually Transmitted Infections

Screening For Sti In Hiv Infection

Some people living with HIV remain active sexually and hence are vulnerable to STI if safer sex practice is not consistently adopted. Recommendations on STI screening are developed in the US and UK with the objective of improving sexual health for people living with HIV. Such strategy carries also public health implication in the early detection of STI followed by not just treatment but appropriate behavioural interventions. In the process of implementing these recommendations, the service providers may need to strengthen their capacity in areas such as sexual health risk assessment and counselling, clinical and laboratory management of concerning STI, partner management, and sexual health referral network.

Screening strategies vary from one setting to another. Box 39.4 shows a protocol for use in HIV specialist clinic or primary care services.

Further tests for other STI or collection of clinical samples from sites other than those specified in Box 39.3 are indicated by results of clinical assessment. More frequent STI screening may be appropriate depending on individual risk behaviour, local STI epidemiology especially in an outbreak situation. The protocol is not meant to replace routine clinical management of people with symptomatology or clinical features suggestive of STI.

Screening For Stis In Persons Living With Hiv

In order to adequately address the ongoing burden of STIs in persons with HIV, it is critical to implement routine screening strategies and follow evidence-based treatment guidelines . The 2021 STI Treatment Guidelines outline appropriate STI screening for persons with HIV . The highest priority for screening is to test for common curable STIs, including chlamydia, gonorrhea, and syphilis, in men and women, as well as trichomoniasis in women. In sexually active persons with HIV, screening for these STIs should be performed at the initial evaluation and then at least annually thereafter. More frequent screening may be appropriate depending on individual risk behaviors and local epidemiology of specific STIs.

Hiv And Stds Are Spread In The Same Ways

You can get HIV or an STD by having sex without a condom with a person who is already infected. HIV and some STDs can be passed from a mother to her baby while she is pregnant, during birth or through breast feeding. HIV and some STDs can also be spread by sharing drug “works” with someone who has HIV or an STD.

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What Is The Connection Between Hiv And Other Stds

Behaviors that put people at risk for HIV also increase their risk for other STDs. These behaviors include the following:

• Having sex without a condom.
• Having sex with many partners, especially anonymous partners.
• Having sex while using drugs or alcohol. Using drugs and alcohol can affect a person’s judgement, which can lead to risky behaviors.

Having an STD can make it easier to get HIV. For example, an STD can cause a sore or a break in the skin, which can make it easier for HIV to enter the body. Having HIV and another STD may increase the risk of HIV transmission.

Why Does Having An Std Put Me More At Risk For Getting Hiv

If you get an STD, you are more likely to get HIV than someone who is STD-free. This is because the same behaviors and circumstances that may put you at risk for getting an STD also can put you at greater risk for getting HIV. In addition, having a sore or break in the skin from an STD may allow HIV to more easily enter your body. If you are sexually active, get tested for STDs and HIV regularly, even if you dont have symptoms.

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Health Services For Screening And Treatment Of Stis Remain Weak

People seeking screening and treatment for STIs face numerous problems. These include limited resources, stigmatization, poor quality of services and often out-of-pocket expenses.

Some populations with the highest rates of STIs such as sex workers, men who have sex with men, people who inject drugs, prison inmates, mobile populations and adolescents in high burden countries for HIV often do not have access to adequateand friendly health services.

In many settings, STI services are often neglected and underfunded. These problems lead to difficulties in providing testing for asymptomatic infections, insufficient number of trained personnel, limited laboratory capacity and inadequate supplies ofappropriate medicines.

Protecting Your Sexual Partners

If you have HIV, are taking HIV medicine exactly as prescribed, and get and keep an undetectable viral load, you will not transmit HIV to an HIV-negative partner. However, while having an undetectable viral load will prevent you from passing HIV, it will not prevent you from transmitting other STIs to your sexual partners. Using condoms the right way every time can prevent the transmission of other STIs like gonorrhea and chlamydia. Routine testing for STIs is also important .

If you have a detectable viral load and another STI, you are at risk for transmitting both HIV and other STIs to your partners. But you can protect your partners from HIV and other STIs by using condoms and choosing less risky sexual behaviors.

And if you have an HIV-negative partner who has another STI, they may have skin ulcers, sores, or inflammation that may increase their risk of getting HIV during sex.

An HIV-negative partner can take medicine to prevent HIV, called pre-exposure prophylaxis, or PrEP, but PrEP does not protect against other STIs. PrEP is an HIV prevention option for people who dont have HIV but who are at risk of acquiring HIV. PrEP involves taking HIV medicines exactly as prescribed to reduce the risk of HIV infection. Both oral HIV medicines and a long-acting injectable form of PrEP are available.

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How Can A Person Reduce The Risk Of Getting An Std

Sexual abstinence is the only way to eliminate any chance of getting an STD. But if you are sexually active, you can take the following steps to lower your risk for STDs, including HIV.

Choose less risky sexual behaviors.

• Reduce the number of people you have sex with.
• Do not drink alcohol or use drugs before and during sex.

Use condoms correctly every time you have sex.

• Visit this website from the Centers for Disease Control and Prevention to learn how to use condoms correctly.

Stis And Prevention Trials

The role of STIs in the spread of HIV led to a series of randomized clinical trials designed to reduce the incidence of HIV infection in communities -, in individuals , and in serodifferent couples -. Of the nine clinical trials, successful prevention of HIV through treatment of STIs was only noted in Mwanza, Tanzania . The differing results of these trials have been extensively reviewed , , , . Failure to see population level prevention of HIV acquisition by more aggressive or mass treatment of STIs is best ascribed to the difficulty of providing effective drugs to the right people at the right time, and the difficulty of assuring that the trial participants are able to adhere to the antimicrobial regimens selected.

An alternative approach has been to focus on HSV-2 treatment to prevent individual HIV acquisition , or transmission . HSV-2 was chosen as a key target because it is such a common infection and so strongly associated with HIV transmission , . Acyclovir was used to suppress HSV-2 replication. No prevention benefit was observed whether the agent was used to treat HIV positive or negative people . It seems likely that subclinical inflammation in spite of treatment reduced the anticipated benefit of acyclovir . Mugwanya et al. has reported that high-dose valacyclovir might reduce HIV-1 infectiousness more than acyclovir treatment used in earlier clinical trials.

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Will Treating Stds Prevent Me From Getting Hiv

No. Its not enough.

If you get treated for an STD, this will help to prevent its complications, and prevent spreading STDs to your sex partners. Treatment for an STD other than HIV does not prevent the spread of HIV.

If you are diagnosed with an STD, talk to your doctor about ways to protect yourself and your partner from getting reinfected with the same STD, or getting HIV.

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What Should My Teen Do If Diagnosed With An Sti

• Have your teen start treatment right away. He or she should take the full course of medicines, and follow their healthcare provider’s advice.

• Tell all recent sex partners and urge them to get healthcare checkups. If your teen does not want to do this personally, your local health department can help.

• Your teen should not have sex while being treated for an STI. If your teen’s partner also needs treatment, they should wait until their treatment is done as well.

• Your teen should have a follow-up test to be sure the STI has been successfully treated.

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What Puts You At Risk For Stds And Hiv

You’re at risk if you:

• Have sex without using a condom, with someone who is infected.
• Have had an STD.
• Have more than one sex partner.
• Are under the influence of drugs and alcohol.

• Many women have STDs without having symptoms. This means that unless she gets tested, she may have an STD and not know it.

If you are a woman, take charge of your sexual health. Be sure to schedule pelvic exams and pap smears every year. Get tested and learn how to protect yourself from STDs and HIV.

Goal: Reduce Sexually Transmitted Infections And Their Complications And Improve Access To Quality Sti Care

Although many sexually transmitted infections are preventable, there are more than 20 million estimated new cases in the United States each year and rates are increasing.1 In addition, more than 1.2 million people in the United States are living with HIV .2Healthy People 2030 focuses on preventing and treating STIs, including HIV, and on improving the health and well-being of people who have them.

Adolescents, young adults, and men who have sex with men are at higher risk of getting STIs. And people who have an STI may be at higher risk of getting HIV. Promoting behaviors like condom use can help prevent STIs.

Strategies to increase screening and testing for STIs can assess peoples risk of getting an STI and help people with STIs get treatment, improving their health and making it less likely that STIs will spread to others. Getting treated for an STI other than HIV can help prevent complications from the STI but doesnt prevent HIV from spreading.3

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Get Tested And Treated For Stis

If you are sexually active, getting tested for STIs is one of the most important things you can do to protect your health and your partners health. Make sure you have an open and honest conversation about your sexual history and STI testing with your health care provider and ask whether you should be tested for STIs.

Depending on your symptoms and sexual activities, the provider may perform a three-site test of your throat, genitals, and rectum. Dont be embarrassed to get tested for an STI. Your health care provider is used to discussing sexual health. Besides, CDC estimates that there are more than 20 million new STI infections every year. So you are not alone and arent the only person talking to your health care provider about an STI.

Encourage your partner to get tested too. You or your partner might have an STI without having symptoms. You and your partner should determine what sexual behaviors and prevention practices are going to be used in your relationshipand outside of it if you are not exclusive. The goal of this communication is to keep you BOTH healthy and free from new infections. Here are some great tips on talking with your partner.

If you test positive, know that getting an STI is not the end! Many STIs are curable and all are treatable. If either you or your partner is infected with an STI that can be cured, both of you need to start treatment immediately to avoid getting re-infected.

Topics

Substance Use And Stis

Analyses showed that men who had recently had an STI were significantly more likely to have used powder forms of cocaine, 2 = 13.7, p < 0.01, crack cocaine, 2 = 14.3, p < 0.01, and use of any non-alcoholic drug in the past 3 months, 2 = 10.1, p < 0.01, compared with men who did not have an STI. Among women, having had an STI was not associated with the use of any single type of drug, although women who reported a recent STI were significantly more likely to have used non-alcoholic drugs in the past 3 months, 2 = 22.9, p < 0.01. Collapsing across sexes, people with a recent STI were significantly more likely to use powder forms of cocaine, 2 = 13.9, p < 0.01, crack cocaine, 2 = 16.9, p < 0.01, and any non-alcoholic drug, 2 = 11.6, p < 0.01, compared with people who did not have an STI . When all of the individual substance use variables were included in a multiple logistic regression analysis, only use of crack cocaine predicted having had an STI, OR = 1.6, 95% CI = 1.12.6.

Table 3

Substance use among men and women living with HIV-AIDS and diagnoses/symptoms of an STI in the past 3 months

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Learning Objective Performance Indicators

• Describe the recommendations for sexually transmitted infection screening in persons with HIV
• List the CDC recommended treatments for the most common sexually transmitted infections in persons with HIV
• Summarize different stages of syphilis and recommended treatments at each stage
• Discuss laboratory-based methods for diagnosing syphilis

DisclosuresAley G. Kalapila, MD, PhDDisclosures

Stis And Susceptibility To Hiv

Transmission of classical STIs is generally more efficient than HIV, and therefore may set the stage for increased risk of HIV acquisition . Inflammation and ulcers can be expected to lower the barrier to infection , , . Recent studies have tried to more precisely define the conditions that lead to HIV acquisition in women, with a focus on unique cytokine profiles , and disturbance of vaginal microbiome with resultant âdysbiosisâ . STIs can evoke an influx of receptive cells with expression of a greater number of CCR5 and CD4 receptors per cell . The risk of HIV acquisition for a woman with mucosal inflammation or a genital ulcer is greatly increased . Trichomonas infection in women, a common pathogen, also increases HIV acquisition . It should be noted that people with an STI appear to be susceptible to an HIV viral variant with reduced fitness .

The foreskin is a critical point of acquisition of HIV by men. It has been argued that low-grade inflammation in this tissue, perhaps critical to decrease commensal bacterial colonization and to resist STIs, increases the risk of HIV acquisition , . Circumcision greatly decreases the risk of HIV infection . Circumcision also appears to reduce the risk of genital ulcer disease in men .

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How Is Hiv Not Spread

HIV is not spread by:

• Mosquitoes, ticks, or other insects
• Saliva, tears, sweat, feces, or urine that is not mixed with the blood of a person with HIV
• Shaking hands hugging sharing toilets sharing dishes, silverware, or drinking glasses or engaging in closed-mouth or social kissing with a person with HIV
• Drinking fountains
• Other sexual activities that dont involve the exchange of body fluids .

Improving Sexually Transmitted Infection Screening And Treatment Among People With Or At Risk For Hiv

Sexually transmitted infections are known to increase the risk of HIV transmission and acquisition with risky sexual behaviors. Although the national incidence of HIV infection has decreased over recent years, the rates of common STIs such as chlamydia , gonorrhea , and syphilis have not. In addition to increasing the risk of HIV transmission from a non-virally suppressed person, STIs are a continuing public health concern because of other associated morbidities and mortalities. Despite national recommendations for screening and treating STIs in people with HIV or at risk for HIV, gaps exist in the regular screening, treatment, and prevention of STIs among people with HIV.

This SPNS Initiative implemented needs-based training, clinical and non-clinical interventions. The goal was to improve screening, testing, and treatment of common bacterial STIs among people with HIV or at risk for HIV who are served by HRSAs Ryan White HIV/AIDS Program and/or Bureau of Primary Health Care funded clinics or health centers. Nine clinical demonstration sites in three United States jurisdictions, Florida, Louisiana, and Washington, D.C., were selected to participate in this pilot demonstration project because of higher than national average incidences of GC, CT, syphilis, and HIV.

Based on findings from the needs assessment the nine clinical demonstration sites implemented the following interventions:

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Stis In People With Hiv

The connection between classical STIs and HIV surfaced early in the epidemic and was first referred to as âepidemiologic synergyâ by Wasserheit . Subsequent studies have paid considerable attention to biologic mechanisms to explain how STIs promote HIV transmission -. Such research studies suggested two important roles for STIs: increased infectiousness of the HIV-positive person and increased susceptibility of the HIV-negative person . Increased infectiousness appears to reflect increases in HIV concentration in genital secretions and changes in viral phenotype of HIV variants that favour transmission.

Selected Sti In Hiv Infection

Both ulcerative and non-ulcerative STI facilitate HIV transmission by a factor of 2-5 times, more for ulcerative comparing to non-ulcerative ones. On the other hand, STI is not uncommonly found in people with HIV infection. In Hong Kong, a cross sectional study conducted in 2005 revealed that 5.1% of sexually active people attending an HIV clinic had either gonococcus or Chlamydia trachomatis infection from urine PCR screening. These observations highlight the importance of STI screening, diagnosis and treatment for HIV-infected people.

The clinical presentations, natural course and management of STI in people with HIV are usually the same as those non HIV-infected people. Nevertheless, atypical presentations and interactions of significant clinical or public health interest have been extensively reported in the literature.

Anogenital herpes

Increased genital shedding of both HIV and herpes simplex virus type 2 in women co-infected with both viruses was reported. Shedding of HSV-2 in co-infected women is twice as high in level as those not infected with HIV. Moreover, women with HIV are more likely to have higher HIV RNA copy number in their blood. There are ongoing studies of using suppressive acyclovir as a therapy to lower HIV load and transmission. Atypical presentations such as large atypical anogenital ulcer recalcitrant to conventional treatment and hyperplastic or nodular growth were reported in the literature.

Anogenital wart

Syphilis and HIV

Dark ground microscopy

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